The Singapore Ministry of Health (MOH) has recently concluded a public consultation on the draft Healthcare Services Bill (HCS Bill), which is intended to replace the existing regulatory framework set out in the Private Hospitals and Medical Clinics Act (PHCMA).
The PHCMA was designed to ensure patient safety through the licensing of physical premises delivering healthcare, such as hospitals, medical clinics, clinical laboratories and other healthcare establishments. In light of advancements in medical and health technologies, it is envisaged that the HCS Bill will better safeguard patient safety in the changing healthcare environment while enabling the development of new and innovative services.
Some of the key changes proposed in the HCS Bill are set out below.
1. For healthcare providers
Healthcare providers will be licensed on the basis of the type of services provided, as opposed to being licensed on physical premises as is currently the case under the PHCMA. This is to take into account the changes in medical technologies where more services are provided virtually and/or remotely, as well as mobile medical services where healthcare services are provided outside bricks-and-mortar establishments.
The MOH has grouped the licensable healthcare services into six broad categories, which include Hospital Services and Non-Premise Based Services. An establishment might require multiple licenses depending on the services provided. The MOH is also considering bundling some commonly used services licensing to reduce costs for the licensee. License conditions will depend on the type of service provided and some services will require other licenses as a pre-requisite.
Allied health, nursing, traditional medicine
Under the HCS Bill, the regulatory scope will be broadened to include allied health (such as physiotherapy and radiation therapy) and nursing services, traditional medicine and complementary and alternative medicine services. However, whilst within the scope of the HCS Bill, such services will not be licensed under the HCS Bill for the time being. At present, the MOH regulates professionals such as allied health professionals and traditional Chinese medicine practitioners under existing legislation and will continue to do so to ensure patient safety. The MOH is taking a risk-based regulatory approach in licensing the services themselves and will wait to see how the landscape evolves in respect of these services. Thereafter, the MOH might consider licensing these services under the HCS Bill in a phased manner.
2. National Electronic Health Record
Under the HCS Bill, all healthcare service providers will have to contribute certain core patient data to the National Electronic Health Record (NEHR). At present, the contribution of data to NEHR is optional.
The information from NEHR can be accessed while treating a patient. The aim is to have patient records follow the patients across multiple healthcare service providers, and protect the information even if the provider ceases functioning.
The HCS Bill addresses privacy concerns with measures such as the following:
- Patient data may be accessed for providing healthcare services only or with approval by the government.
- Other third parties such as employers and insurance providers will not have access to the data unless the patient grants access.
- Patients who do not wish for their records to be accessed via the NEHR may choose to opt out and block access to the data by healthcare providers (though the data will still be uploaded to the NEHR in the first place).
The MOH may also consider allowing some patients not to upload certain information on the NEHR, on a case-by-case basis (though this provision is not included in the HCS Bill at present).
Parts III to VI of the Personal Data Protection Act 2012 will not apply to the access, use, and contribution of health information to the NEHR.
3. For patients
The HCS Bill also introduces a variety of measures to enhance patient protection, including the following:
- The MOH will publish information about healthcare providers whose licenses have been suspended or revoked, to increase awareness by the public.
- Unsafe treatments will be prohibited.
- Penalties (fines and custodial sentences) for offences under the PHCMA will be enhanced under the HCS Bill.
- The MOH may make regulations to prohibit certain individuals from being employed by healthcare providers, to protect the safety and welfare of vulnerable patient groups.
4. Other new provisions
The HCS Bill introduces measures to avoid public misperception in the healthcare space:
New licensees cannot have the words “Singapore” or “National” in their names. Existing licensees will not be affected.
Non-licensees cannot use names that are similar to licensable healthcare services.
A hospital must provide Accident & Emergency services to call itself a “General Hospital”.
The HCS Bill also has “step-in” provisions in respect of residential care services such as hospitals, nursing homes and in-patient palliative care services. The step-in provisions will be a last resort mechanism to allow the MOH to take over the operations of providers at risk of insolvency or who are unable to resolve systemic patient safety or welfare issues.
When will these changes be coming into force?
The MOH hopes to have the HCS Bill enacted during the second half of this year and implement it in three phases beginning December 2019.
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